RADIOLOGICAL DESCRIPTION OF

FUNGAL INFECTIONS IN LUNG

 1.
BACKGROUND
Let’s start with the first set of slides
 BACKGROUND

‐ Aspergillosis is a disease caused by aspergillus.

‐ Many types of aspergillus 

‐ Aspergillus fumigatus
‐ Aspergillus flavus
‐ Aspergillus niger
‐ Aspergillus nidulans
‐ Aspergillus terreus

‐ Radiological diagnosis of aspergilloma is done by chest radiograph and chest CT scan to identified an abnormality
in each thorax cavity.

‐ General form from aspergillosis are alergy bronchopulmonary aspergillosis, pulmonary aspergilloma and invasive
aspergillosis
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 2.
LITERATURE REVIEW
Let’s start with the first set of slides
 DEFINITION
Aspergillosis is an infection caused
by Aspergillus, a common mold (a type of
fungus).

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 ETIOLOGY

A.Fumigatus
Aspergillus flavus
Aspergillus terreus

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 EPIDEMIOLOGY

‐ 90% cases of aspergillosis is

caused by A. fumigatus.
‐ 60% cases of aspergillosis is
caused by A. flavus, A.niger and
A.terreus

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PATOPHYSIOLOGY

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CLASSIFICATION

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 Pulmonary Aspergilloma
Definition
‐ A mass like fungus ball composed by Aspergillus fumigatus,
a non-invasive form from aspergillosis pulmonal.
Clinical manifestation
‐ Asymptomatic
‐ Could be hemoptysis, cough and fever
‐ History of lung cavity/pulmonal disease
X-RAY :
‐ Pleura thickening
‐ Monod sign
‐ Air crescent sign
CT-Scan Thorax
‐ Air crescent sign  upper lobe
‐ Fungus ball can change position. 10
 Allergic Bronchopulmonary Aspergillosis
Definition
immunological pulmonary disorder caused by
hypersensitivity to Aspergillus fumigatus,
manifesting with poorly controlled asthma,
recurrent pulmonary infiltrates and bronchiectasis
Clinical manifestation
‐ History of asthma
‐ Hemoptysis, wheezing, productive cough
X-RAY
‐ Thickening of airway tract and hyperinflation
‐ Opacity in central tubular  upper lobe
‐ Finger in glove sign
CT-Scan
‐ Bronchiectasis
‐ Mucoid impaction
‐ Centrilobular nodules
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 Angioinvasive aspergillosis
Definition :
Can be found in patient with immunocompromised with severe neutropenia. Prolonged
high dose steroid
Clinical manifestation :
‐ Hard to diagnose
X-RAY :
‐ Multiple or solitaire nodules/mass
‐ Invasion of proximal vascular
‐ Air crescent sign
CT-SCAN
‐ Nodule (bilateral and asymmetrical)
‐ Halo sign
‐ Ground glass opacification
‐ Air crescent sign
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Definition :
AIRWAY INVASIVE ASPERGILLOSIS
A condition that present in immunocompromised patient especially
neutropenia and AIDS.
Clinical manifestation :
‐ Acute Tracheobronchitis
‐ Bronchiolitis
‐ Bronchopneumonia

X-RAY :
‐ Patchy in unilateral/bilateral from air space consolidation
‐ Solitair/multiple nodule
‐ Air crescent
CT-SCAN
‐ Tracheobronchitis
‐ Bronchiolitis  tree-in-bud nodularity
‐ bronchopneumonia
 Chronic Necrotizing Aspergillosis
Definition :
Associated with chronic disease, DM, corticosteroid and COPD. (could be
immunocompetent)
Clinical manifestation :
‐ Chronic cough
‐ Sputum production
‐ Fever
X-RAY :
‐ Nodule cavity 1/>
‐ With / without fungus ball
‐ Consolidation area with or without cavity
‐ pleura thickening
CT-Scan :
‐ Lobar consolidation
‐ Fungus ball 50% cases
‐ Pleura thickening
‐ Tree in bud sign
 Obsrtuctive bronchopulmonary aspergillosis1

Definition :
Noninvasive aspergillosis form , characterized
by overgrowth of aspergillus intraluminal in
AIDS patient
Clinical manifestation :
‐ Cough
‐ Severe hypoxemia
CT SCAN :
‐ Similar to ABPA
‐ Bronchiolar dilation
‐ Mucoid impaction lower lobe
‐ Diffuse Consolidation caused by atelectasis
postobstructive 15
 Differential diagnosis

Tuberculosis of lungs
‐ Consolidation
‐ Centrilobular nodule
‐ Cavity

Lung abcess
‐ cavity with thickening
wall
‐ Air fluid level
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 DIAGNOSIS

Beside history taking and physical examination, we

need laboratory and radiological examination to
establish the diagnosis, such as :
‐ Microscopic examination
‐ Culture specimen
‐ Skin test
‐ Serologic test
‐ Molecular diagnosis
‐ Radiological examination
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 Management

Management of
aspergillosis depend of
the etiology :
‐ Aspergilloma 
surgical resection
‐ Invasive
aspergilloma 
antifungal
‐ ABPA 
corticosteroid +
antifungal
 Thank you

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